Parker College of Chiropractic is a nonprofit, co-educational, private professional institution of higher education. The purpose of the College is the preparation of men and women to become Doctors of Chiropractic, who will then serve as primary health care providers and perpetuate chiropractic services worldwide for the benefit of all mankind.

Parker College is committed to the maintenance of chiropractic as a separate and distinct healing art which addresses primarily the location and detection of spinal misalignments, dysfunctions and subluxations affecting neural integrity. Correction is achieved by either force or non-force spinal and/or extraspinal techniques.

The integration of this wellness philosophy principle is woven through the basic science, chiropractic science, clinical science and techniques department.

Fibromyalgia: Diagnosis

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s):

Dwain M. Daniel, D.C.

Dwain M. Daniel, D.C.

Dr. Dwain Daniel graduated from Cleveland Chiropractic College in 1981 and opened his private practice in San Antonio, Texas in 1982. He was in solo practice until 2000 when he accepted the position of Associate Director of Research at Parker College of Chiropractic. In 2002 he was selected as the Chairperson for the Department of Diagnosis and Clinical Applications. In 2006 he returned to the Research Institute to become the Research-Faculty Liaison for the college. His primary mission is to develop reviews on evidence-based prevention, diagnosis and treatment of a variety of commonly encountered conditions and to assist faculty research. This new and unique position is critical to the educational process in a rapidly changing information and evidence based health care environment. Dr. Daniel received his B.A. degree from Texas State University, is a past President of the Texas Chiropractic Association, District 10, and has earned a Chiropractic Certification in Spinal Trauma (CCST). He has had several papers published in the peer reviewed press and teaches informatics and evidence-based practice to chiropractors throughout the United States.

For more information on the Strength of Recommendation Taxonomy (SORT), please click here.

Published on

October 1, 2006

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On initial examination fibromyalgia appears to be a relatively straight-forward diagnostic procedure. The patient presents with spontaneous, widespread soft tissue pain, sleep disturbances, fatigue and widely distributed tender points evaluated by procedures developed by the American College of Rheumatology (ACR) (1). Although diagnosis may seem rather simple it can, in fact, be challenging. A recent paper found only 34% of patients diagnosed with FM received an accurate diagnosis (2). Hypothyroidism, drug-induced myopathies (often associated with statins, lipid-lowering drugs), myofascial pain syndrome, lupus and other rheumatic conditions can mimic fibromyalgia. Often the diagnosis is made, at least in part, by elimination of other conditions. One must take a very careful history, perform a skilled examination and use astute observation over time. Additionally the ACR states the diagnosis of FM cannot be made until lab testing returns negative. To rule out the above mentioned conditions, the following tests are recommended: red blood cell count with differential, thyroid function tests, metabolic screening panel, C-reactive protein, erythrocyte sedimentation rate, Lyme test and rheumatic profile (3).

In order to view the full content of this review, which includes information broken down by topic, you must be a registered user of ChiroACCESS. The primary mission of ChiroACCESS is to disseminate accurate user-friendly information to practicing chiropractors, faculty and students of chiropractic in order to ensure the best possible patient care.

The proportion of new cases of the target disorder in the population at risk during a specified time interval. It is usual to define the disorder, and the population, and the time, and report the incidence as a rate.

For some examples of incidence studies, two of the best relate to how Parkinson's disease incidence varies with latitude, and how Perthes' disease (a developmental problem of the hip joint affecting younger children) varies with deprivation.

Information provided courtesy of Oxford University and Bandolier.

Randomised Controlled Clinical Trial

A group of patients is randomized into an experimental group and a control group. These groups are followed up for the variables/outcomes of interest. The point about using randomization is that it avoids any possibility of selection bias in a trial. The test that randomization has been successful is that different treatment groups have same characteristics at baseline. For instance, there should be the same number of men and women, or older or younger people, or different degrees of disease severity.

Information provided courtesy of Oxford University and Bandolier.

Systematic Review

A summary of the medical literature that uses explicit methods to perform a thorough literature search and critical appraisal of individual studies and that uses appropriate statistical techniques to combine these valid studies.

Systematic reviews are not all equal, and quality issues are important. Guidance for reviewing reviews is worth a read.

Anyone thinking about performing a systematic review would do worse than to read the simple practical guidance on how to do a Cochrane review by Frances Fairman and friends.

Information provided courtesy of Oxford University and Bandolier.

Validity

In diagnostic tests validity is the extent to which a test measures what it was intended to measure. High reliability is necessary but does not guarantee high validity.

Information provided courtesy of Oxford University and Bandolier.

Positive Predictive Value

Proportion of people with a positive test who have the target disorder.

Information provided courtesy of Oxford University and Bandolier.

Positive Predictive Value

Proportion of people with a positive test who have the target disorder.

Information provided courtesy of Oxford University and Bandolier.

P-Value

The probability (ranging from zero to one) that the results observed in a study (or results more extreme) could have occurred by chance. Convention is that we accept a p value of 0.05 or below as being statistically significant. That means a chance of 1 in 20, which is not very unlikely. This convention has no solid basis, other than being the number chosen many years ago. When many comparisons are bing made, statistical significance can occur just by chance. A more stringent rule is to use a p value of 0.01 ( 1 in 100) or below as statistically significant, though some folk get hot under the collar when you do it.

Information provided courtesy of Oxford University and Bandolier.

Longitudinal Study

A study of the same group of people at more than one point in time. (This type of study contrasts with a cross-sectional study, which observes a defined set of people at a single point in time.)

Information provided courtesy of Oxford University and Bandolier.

Cross-Sectional Study

The observation of a defined population at a signal point in time or time interval. Exposure and outcome are determined simultaneously.

Information provided courtesy of Oxford University and Bandolier.

Crossover Study Design

The administration of two or more experimental therapies one after the other in a specified or random order to the same group of patients. There are some important issues with cross-over designs. Two in particular often crop up.

First is the issue of order effects, in which the order in which treatments are administered may affect the outcome. An example might be a drug with many adverse events given first making patients taking a second, less harmful medicine, more sensitive to any adverse effect.

Second is the issue of carry-over between treatments. In practice carry-over can be dealt with by use of a wash-out period between treatments, or by making observations sufficiently later after the start of a treatment period that any carry-over effect is minimized.

Information provided courtesy of Oxford University and Bandolier.

Confidence Interval (CI)

Quantifies the uncertainty in measurement. It is usually reported as 95% CI, which is the range of values within which we can be 95% sure that the true value for the whole population lies. For example, for an NNT of 10 with a 95% CI of 5 and 15, we would have 95% confidence that the true NNT value was between 5 and 15.

A caveat is that the confidence interval relates to the population sampled. If we have a small sample of part of a population, or a very small sample of the whole population, then the confidence interval that is generated is not necessarily that for the whole population.

Information provided courtesy of Oxford University and Bandolier.

Case Report

A report on a single patient with an outcome of interest.

Information provided courtesy of Oxford University and Bandolier.

Case Series

A report on a series of patients with an outcome of interest. No control group is involved.

Information provided courtesy of Oxford University and Bandolier.

Case-Control Study

A study which involves identifying patients who have the outcome of interest (cases) and control patients who do not have that same outcome, and looking back to see if they had the exposure of interest. The exposure could be some environmental factor, a behavioural factor, or exposure to a drug or other therapeutic intervention.

Information provided courtesy of Oxford University and Bandolier.

Cohort Study

Involves identification of two groups (cohorts) of patients one which received the exposure of interest, and one which did not, and following these cohorts forward for the outcome of interest.

Information provided courtesy of Oxford University and Bandolier.

Specificity

Proportion of people without the target disorder who have a negative test. It is used to assist in assessing and selecting a diagnostic test/sign/symptom.

When a sign/test/symptom has a high Specificity; a Positive result rules in the diagnosis.

Information provided courtesy of Oxford University and Bandolier.

Sensitivity

Proportion of people with the target disorder who have a positive test. It is used to assist in assessing and selecting a diagnostic test/sign/symptom.

When a sign/test/symptom has a high Sensitivity: a Negative result rules out the diagnosis.

Information provided courtesy of Oxford University and Bandolier.

Number Needed to Treat (NNT)

The inverse of the absolute risk reduction or increase and the number of patients that need to be treated for one to benefit compared with a control. The ideal NNT is 1, where everyone has improved with treatment and no-one has with control. The higher the NNT, the less effective is the treatment. But the value of an NNT is not just numeric. For instance, NNTs of 2-5 are indicative of effective therapies, like analgesics for acute pain. NNts of about 1 might be seen by treating sensitive bacterial infections with antibiotics, while an NNT of 40 or more might be useful, as when using aspirin after a heart attack.

Information provided courtesy of Oxford University and Bandolier.

Number Needed to Treat (NNT)

The inverse of the absolute risk reduction or increase and the number of patients that need to be treated for one to benefit compared with a control. The ideal NNT is 1, where everyone has improved with treatment and no-one has with control. The higher the NNT, the less effective is the treatment. But the value of an NNT is not just numeric. For instance, NNTs of 2-5 are indicative of effective therapies, like analgesics for acute pain. NNts of about 1 might be seen by treating sensitive bacterial infections with antibiotics, while an NNT of 40 or more might be useful, as when using aspirin after a heart attack.

Information provided courtesy of Oxford University and Bandolier.

Meta-Analysis

A systematic review that uses quantitative methods to summarise the results.

A meta-analysis is where we pool all the information we have from a number of different (but similar) studies. It should not be about adding small piles of rubbish together to make a big pile of rubbish. It is only worth doing when individual trials are themselves of sufficient quality and validity. What meta-analysis does is to give enough size to have the power to see the result clearly, without the noise of the random play of chance.

Any meta-analysis must have enough events to make sense. Combining small, poor, trials, with few events will mislead.

Information provided courtesy of Oxford University and Bandolier.

Evidence Based Products: ASU-300

The Scientific Evidence for ASU:

From the Cochrane Database of Systematic Reviews, 2001 "The evidence for ASU in the treatment of osteoarthritis is convincing. No serious side effects were reported."

From the journal Osteoarthritis and Cartilage, 2007 "Based on the available evidence, patients may be recommended to give ASU a chance for three months."

From the journal Rheumatology, 2003 "These results suggest ASU could have structure-modifying effects in osteoarthritis by inhibiting cartilage degradation and promoting cartilage repair."

From the journal Ugeskr Laeger, 2005 (Danish) "Four randomized, double blind, placebo-controlled clinical trials have been published. These studies indicate ASU has an effect on the symptoms of knee and hip arthritis."

From the journal Arthritis and Rheumatism, 2002 "ASU demonstrates significantly reduced progression of joint space as compared with placebo in the subgroup of patients with advanced space narrowing. The results suggest ASU could have a structural effect."

From the Cochrane Database of Systematic Reviews, 2001 "The evidence for ASU in the treatment of osteoarthritis is convincing. No serious side effects were reported."

From the journal Osteoarthritis and Cartilage, 2007 "Based on the available evidence, patients may be recommended to give ASU a chance for three months."

From the journal Rheumatology, 2003 "These results suggest ASU could have structure-modifying effects in osteoarthritis by inhibiting cartilage degradation and promoting cartilage repair."

From the journal Ugeskr Laeger, 2005 (Danish) "Four randomized, double blind, placebo-controlled clinical trials have been published. These studies indicate ASU has an effect on the symptoms of knee and hip arthritis."

From the journal Arthritis and Rheumatism, 2002 "ASU demonstrates significantly reduced progression of joint space as compared with placebo in the subgroup of patients with advanced space narrowing. The results suggest ASU could have a structural effect."

The American Chiropractic Association (ACA), based in Arlington, Va., is the largest professional association in the world representing doctors of chiropractic. The ACA provides lobbying, public relations, professional and educational opportunities for doctors of chiropractic, funds research regarding chiropractic and health issues, and offers leadership for the advancement of the profession. With approximately 15,000 members, the ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients.

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Parker College of Chiropractic

Parker College of Chiropractic, located in Dallas, is one of the country’s leading educators of health care professionals with an international student enrollment. Founded in 1982, this private, non-profit educational institution prepares men and women to become doctors of chiropractic. Parker College of Chiropractic is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools to award the bachelor of science and doctor of chiropractic degrees. Contact the Commission on Colleges at 1866 Southern Lane, Decatur, GA, 30033-4097 or call 404.679.4500 for questions about the accreditation of Parker College of Chiropractic. The doctor of chiropractic degree program of Parker College of Chiropractic isaccredited by the Commission on Accreditation of the Council on Chiropractic Education, 8049 North 85th Way, Scottsdale, AZ, 85258-4321. Tel: 480.443.8877. For additional information about Parker College of Chiropractic, visit the college’s website at www.parkercc.edu.

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Texas Chiropractic College

For more than 100 years, Texas Chiropractic College has been a respected player in America’s landscape of health care education. Our highly ranked programs, together with world-class faculty, unparalleled opportunities for hands-on training, and uncommonly close campus family have earned our chiropractic school a reputation as one of the nation’s finest producers of skilled, thoughtful, ethical Doctors of Chiropractic.

And at TCC, this impressive legacy is matched only by one thing—the significant role we are playing in the future of health care.

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New York Chiropractic College

An education from New York Chiropractic College combines nationally recognized academic and scientific excellence with real-world clinical experience unmatched by other chiropractic schools. In addition, we offer a diverse, yet integrated multi-disciplinary degrees in acupuncture, oriental medicine, and applied clinical nutrition. Student-customized curriculum ensures graduates are fully prepared for the integrated, collaborative healthcare model that is the future of healthcare delivery.

In the end, a degree from NYCC will provide you with the educational knowledge and practical experience you need to accelerate your personal and professional success.

Learn how The NYCC Advantage can deliver a world-class education so you can realize a world of opportunity. Download the NYCC Viewbook.

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Cleveland Chiropractic College

At Cleveland Chiropractic College, you will put health and healing into your own two hands. The science, natural philosophy and time-tested art of chiropractic combine to make it one of the most rewarding — not to mention cost-effective and fastest-growing — health care professions in the world. Chiropractic health care focuses primarily on spinal function and its relationship to the nervous system and good health. Doctors of chiropractic emphasize that the body is a self-regulating and self-healing organism. The chiropractor’s goal is to use spinal and extremity adjusting techniques, along with advice on diet, exercise and positive lifestyle choices, to help the body help itself.

For more than eight decades, Cleveland Chiropractic College has been the place to learn this science, philosophy and art. More than one in every 10 chiropractors practicing in North America is a Cleveland graduate. A career in chiropractic gives you the freedom to determine how, where and in what specialty areas you will practice — Cleveland provides you the balanced, flexible and practical education to excel. We also offer undergraduate and pre-professional programs that can accelerate your career in other health care fields. What do you want your life to be? Look no further than Cleveland Chiropractic College. This is where you can put health in your own two hands.

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World Congress of Chiropractic Students

The World Congress of Chiropractic Students (W.C.C.S.) is an international forum representing the chiropractic profession. There are some 14,000 active WCCS members around the world that represent 31 different chiropractic colleges. Since its inception in 1979 the annual conference brings together an array of international student members to discuss issues pertinent to the chiropractic profession. The WCCS endeavors to accurately distinguish the international student consensus on issues vitally important to the chiropractic profession. The main objectives of the WCCS are to:

‘Unify the chiropractic profession from within and to unify the health care community with the interest of contributing to world health, well-being and to promote the exchange of new ideas from a student perspective.’

Every year the international WCCS chapters converge on one destination for a one week congress to collaborate on significant issues from all over the world.

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Palmer College of Chiropractic

Palmer College of Chiropractic was founded in 1897 by the discoverer of chiropractic, D.D. Palmer, in Davenport, Iowa. Approximately 2,300 students attend Palmer College campuses in Davenport, San Jose, Calif., and Port Orange, Fla. There are more than 26,000 Palmer alumni, who make up more than one third of the approximately 75,000 chiropractors currently in practice worldwide. Palmer’s Doctor of Chiropractic curriculum is a five-academic-year program that is typically completed in three-and-one-third calendar years.

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Dietary Supplements and Nutrition

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Established in 1935, Logan College of Chiropractic is one of the largest chiropractic colleges or universities in North America and graduates approximately 300 chiropractors each year. Logan College has approximately 1,100 students, representing most states and several foreign countries, at its 112-acre campus in Chesterfield, Mo., a western suburb of St.Louis.

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Acupuncture Supplies

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The Tri-Core aligns the spine and supports the neck helping to reestablish its natural position to help relieve neck pain for side and back sleepers alike. Its patented overall design features a unique trapezoid center and two sized top and bottom neck lobes cradles the head and provides the highest quality cervical support available.

National University of Health Sciences is a primary destination for those seeking a professional career in natural health care. Once a single purpose chiropractic college founded in 1906, National’s academic programs now encompass chiropractic medicine, naturopathic medicine, acupuncture, oriental medicine, massage therapy and more. NUHS also offers several continuing education courses for DCs. National’s DC program is offered both at its Lombard, Illinois campus, and at its campus in St. Petersburg, Florida. Call 1-800-826-6285 for more information on NUHS.

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Orthotic Devices

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The Tri-Core aligns the spine and supports the neck helping to reestablish its natural position to help relieve neck pain for side and back sleepers alike. Its patented overall design features a unique trapezoid center and two sized top and bottom neck lobes cradles the head and provides the highest quality cervical support available.

These Hot & Cold packs are tailored to wrap, hug and bring relief to different parts of the body. Core's Dual Comfort CorPak can deliver both cold and heat, and features a soft "frost-free" surface that protects the skin. Different shaped packs to soothe pain from head totoe round out this wide assortment.

Help support the people who make ChiroACCESS possible. The Exhibit Hall at ChiroACCESS is a quick and easy way to locate the best in chiropractic equipment, services and supplies. Visit the Exhibit Hall at ChiroACCESS today!

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These Hot & Cold packs are tailored to wrap, hug and bring relief to different parts of the body. Core's Dual Comfort CorPak can deliver both cold and heat, and features a soft "frost-free" surface that protects the skin. Different shaped packs to soothe pain from head totoe round out this wide assortment.

These Hot & Cold packs are tailored to wrap, hug and bring relief to different parts of the body. Core's Dual Comfort CorPak can deliver both cold and heat, and features a soft "frost-free" surface that protects the skin. Different shaped packs to soothe pain from head totoe round out this wide assortment.

Founded in Marietta, Georgia in 1974, Life University is the largest chiropractic college in the world. Life University is accredited by the Southern Association of Colleges and Schools (SACS) and the Council on Chiropractic Education (CCE) to award four-year undergraduate and graduate degrees in a variety of health care, science, business and general studies fields. The mission of Life University is to empower students with the education, skills and values necessary for career success and life fulfillment, based on vitalistic philosophy.

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